Why the uninsured are sitting out Obamacare

With Obamacare's first enrollment period finally in the books, two new surveys out this morning offer new insight into why the still-uninsured decided to remain on the sidelines this year. Hint: It has a lot to do with cost.

This newest monthly Kaiser Health Tracking poll, which has provided some of the most reliable data on the public's opinion interaction with the Affordable Care Act over the past four years, finds that nearly 4 in 10 uninsured adults cited affordability as their main reason for skipping health insurance coverage. Twenty-two percent cited employment reasons (they were unemployed or couldn't get coverage through their job), while another 11 percent said they missed the deadline and 9 percent said they just didn't want insurance.

And how much of a motivator is Obamacare's individual mandate? When Kaiser asked people about the requirement to have insurance, it didn't change their affordability calculation much — 36 percent cited affordability as their main reason for staying uninsured.


Interestingly, about half (45 percent) of the uninsured said they thought they would have to pay the individual mandate penalty this year, though actual enforcement of the mandate will likely be light this year. Further, the population of people who'd trigger the mandate is likely much smaller — the Congressional Budget Office previously projected just 2 percent of the total population, or 6 million people, would have to pay the mandate penalty in 2016.

The industry-backed Enroll America offers further context on the affordability question in a new report analyzing the group’s efforts to increase enrollment in 10 states. Based on conversations with about 1,350 people who attempted to get insurance but ultimately didn’t, Enroll America found Web site issues (37 percent) and affordability (21 percent) ranked among the top two reasons for not enrolling.

Now, the Enroll America data aren't nationally representative of the population of uninsured Americans, and the group only focuses on individuals in urban areas in 10 states where the federal government is running the local Obamacare insurance marketplace. The report pulls out a couple of trends, though, that are notable.

For starters, complaints about Web site problems decreased each month from November 2013 to February 2014, but they didn’t go away entirely. More than half of consumers (56 percent) in November reported technical problems, which decreased to 27 percent in February, according to the Enroll America report.

Meanwhile, the group said complaints about the lack of affordable health-care options increased each month during the signup period (8 percent of complaints in November, compared to 29 percent in February). Enroll America said this could be a reflection of more people advancing to the point where they had to pick a health plan.

We’ve heard all along from the industry that sicker people would be among the first to sign up for Obamacare insurance – and cost could be less of an enrollment barrier for them, since they have greater health-care needs. People who waited longer to sign up were expected to be more sensitive to price since they didn’t feel as great of a need for coverage.

Ultimately, you'd expect in the future that Web site problems that plagued the roll-out this past year will be less of an issue going forward. The affordability question, though, isn't going away.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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